Stroke Rehabilitation and Aphasia:
‘Communication is still very much possible’
May is National Stroke Awareness Month, which offers the opportunity to look closely at how people recover and reintegrate into their lives following stroke. Because the brain governs movement, language, cognition and behavior, a stroke—which is a form of brain injury—can affect any or all of these functions, depending on where it occurs and how much tissue is damaged. Every 40 seconds, someone in the United States has a stroke, but it’s important to note that no two strokes are alike, and no two rehabilitation journeys follow the same pathway.
The brain is most adaptable in the early period after injury, and intensive rehabilitation takes advantage of that window. During inpatient rehabilitation at Burke, for example, people recovering from stroke receive intensive therapy for at least three hours a day, stimulating the brain to form new pathways. “The more consistent and targeted the therapy, the more we can help drive that recovery,” says Dr. Clayton Mucha, a physiatrist specializing in neurorehabilitation and brain injury medicine at Burke Rehabilitation® and co-director of the Spasticity Program.
Burke cares for the most stroke patients in New York.* Integrated team care is essential because stroke patients aren’t recovering one skill in isolation—they are relearning how to function across multiple areas at once. Physical and occupational therapists and speech-language and swallowing pathologists work closely together, along with the rehabilitation physician, who monitors neurological status and manages the factors that directly affect a patient’s ability to engage in therapy—fatigue, sleep, mood, medications. The team meets regularly; the plan adjusts constantly.
Aphasia: The Person Is Still There
Among the many complications that stroke can cause, aphasia can be one of the most frustrating and least understood by families confronting it for the first time. Between 20 and 40 percent of stroke survivors develop the condition, which disrupts the ability to produce language—to speak, read, or write—as well as to understand spoken or written language.
A common misconception, Dr. Mucha explains, is that aphasia reflects a loss of intelligence. It does not. “Patients often understand far more than they can express,” he says. "The damage is to the pathway between thought and expression, not to the thinking itself."
Dr. Mucha encourages families to think about communication more broadly than spoken language. Gestures, facial expressions, writing, and a shared understanding between people who know each other well—these all comprise communication. “I let families know that communication may not look exactly the same as before,” he says. “It can be difficult at first, but communication is still very much possible.”
He encourages caregivers to simplify how they communicate and to give the patient extra time; don’t rush or interrupt. That, he says, shows respect and helps the patient rebuild their confidence. “The goal isn’t perfect speech,” Dr. Mucha says. “It’s effective communication—helping patients reconnect with their loved ones and their own lives.”
Revisiting Goals, Preparing for a Marathon
Dr. Mucha emphasizes the importance of setting goals in aphasia recovery, inspired by each individual life and resetting goals as the recovery evolves. Early in the rehabilitation journey, he explains, goals might include communicating basic needs, being able to express pain or hunger, or asking for help. As progress builds, goals expand and might include short conversations, more independent participation in therapy and starting to manage daily activities. From there, goals often target a deeper reintegration into life, whether that’s returning to work, playing with grandchildren, or ordering dinner in a restaurant. These continue in the outpatient setting, following inpatient care.
“We’re all constantly building on the goals in a way that reflects real-life communication,” says Dr. Mucha, “and not just an isolated language task.”
The Intensive Comprehensive Aphasia Program (ICAP) has been successful in changing the rehabilitation trajectory for people living with aphasia. The immersive outpatient program offers four hours of small-group aphasia therapy each day for four weeks. The latest figures show that every participant has made clinical gains, with many achieving statistically significant improvements in language and quality of life. Beyond the data, people are regaining their voices, their relationships, and their ability to participate in life.
Throughout in- and outpatient rehab, goals are set collaboratively: patient, family, therapists, and the broader rehabilitation team, so everyone is working toward the same outcome. The physician’s role is to ensure the goals align with the patient’s overall clinical trajectory and to address anything getting in the way of progress.
Another misconception in stroke rehabilitation, notes Dr. Mucha, is that improvement happens early and then stops. Early, intensive, coordinated rehabilitation sets the stage—much of the recovery does happen in the first three months. But recovery from stroke is a marathon, not a sprint, and the trajectory of progress continues, gradually, over months and even years. “Even small gains in those months after can really translate into meaningful improvements in daily life,” Dr. Mucha emphasizes.
